The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

Abstract

BackgroundMedical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner.MethodsA qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators.Results52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners’ perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed “GP consultant teacher”). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning.ConclusionsVertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.

‘Thrown in at the Deep End’: The Experience of Graduates of Transnational Western Medical Education Transitioning into Middle Eastern Clinical Practice

“…Ensuring safe practice by feeling supported was provided by team members as well as by alumni or family members who worked in the same hospital. The importance of creating a supportive learning environment for trainee doctors has been recognised as a factor contributing to good-patient care (Thomson et al 2014). Recognised challenges to learning in a busy hospital environment include lack of good supervision (De Lasson et al 2016;Goodyear 2014), less structured, formalised teaching opportunities and more patient-centred autonomous learning (O'Brien and Poncelet 2010).…”

Medical student contact with specialty trainees: Missing out in general practice?

“…Student comments about teaching from registrars resonate strongly with previous literature, including findings that medical students were 'overwhelmingly positive' about learning from general practice registrars 5 and that general practice registrars were perceived to be more 'in tune' with what medical students 'need to know' and 'a little more up to date on some things', 7 with more methodical approaches to consultations. 5 It has also been previously reported in studies of medical student experiences of hospitalbased registrars that the registrar 'makes or breaks the term'. 15…”

“…[2][3][4] Registrar teachers may be sources of high-quality information about training pathways and future careers, 1 and their teaching is valued highly. [5][6][7] A specialty with trainees less visible to medical students may be at a disadvantage in terms of its teaching impact, recruitment success and resilience to 'bad mouthing', 2,4 compared with other, more visible, specialties.…”

“…Medical student contact with general practice registrars may be reduced, compared with their contact with hospitalbased registrars because of the 'closed door' nature of patient consultations in general practice, where general practice registrar work may not be visible to students attached to general practices. 5 There may also be disincentives for general practice registrars to participate in practice-based teaching, including increased patient waiting times for registrars, who often practise more slowly and systematically when a medical student is present during the consultation. 9 In contrast to most general practice supervisors, registrars often receive no payment for teaching, 10 and registrar teachers may resent any loss of income related to a reduced patient load in teaching sessions.…”

Opening the black box of selection

“…By doing so, the SME team ascertained the representation of the derived competencies in the assignments they generated. Total test duration and the number of items needed to achieve a reliable picture was based on assessment literature and CASPer and MMI experiences, indicating how many items/stations are needed to achieve a reliable picture (Dore et al 2017; Table 1 Translation of the CanMEDS competencies into a blueprint of derived competencies for the selection procedure *Combination of two CanMEDS competencies a knowledge and information integration; related to applying knowledge as in the role of medical expert and "creation, dissemination, application and translation of medical knowledge" as in the role of scholar (Frank 2005) b Knorr and Hissbach 2014;Thomson et al 2014;van der Vleuten and Schuwirth 2005): 90 min for 11 items in the V-SJT and 75 min for 8 items in the WAT. At the end of the selection day, several students stated that there was a lot of time pressure, and that they could not finish all assessments.…”